What you need to know when participating in health insurance for 5 consecutive years in Vietnam

What you need to know when participating in health insurance for 5 consecutive years in Vietnam (Artwork)

1. What is health insurance for 5 consecutive years in Vietnam?

According to Article 12 of Vietnam's Decree 146/2018/ND-CP: The consecutive 5-year or longer period of health insurance participation of policyholders making co-payment of healthcare costs. The consecutive period of health insurance participation refers to the date subsequent to the previous date of issue inscribed on a health insurance card; in case of an interval, it must be less than 03 months.

Specifically, Clause 1, Article 3 of Vietnam's Decision 1313/QD-BHXH (effective until April 1, 2021) clearly states that the person participating in health insurance for 5 consecutive years is the person whose card has the words "For 05 consecutive years : From the date ..../../….." printed at the end of the health insurance card, helping the participants in health insurance and medical facilities determine the time of payment of health insurance premiums.

In the event that the participants' health insurance are paid 100% of medical examination and treatment expenses by the health insurance fund, or if the continuous participation period is less than 5 years, leave blank (do not write this criterion).

In the case of having participated continuously for a full 05 years or more, write the time of a full 05 consecutive years as follows:

• Those who have had at least 05 years of continuous participation in health insurance prior to January 1, 2015 must begin recording on that date.

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  Those who have participated in health insurance for a full 05 consecutive years will be recorded from the first day of the sixth year beginning January 1, 2015. 

   

2. Benefits when participating in health insurance for 5 consecutive years

Health insurance is especially important in reducing the financial burden for patients. Most patients are only paid 80% of medical examination and treatment costs within the coverage of health insurance, except for children under 6 years old, people from poor households, ethnic minorities;...

For those who have joined health insurance for 5 consecutive years or more, their benefits are greatly increased. Specifically, Clause 15, Article 1 of the Law on Health Insurance amended in 2014 provides as follows:

Total medical examination and treatment expenditures with regard to the at least 5-year-insured whose medical examination and treatment expenditures exceed the total amount of the base salaries in 6 months, except for the insured who go to the hospitals different from the registered hospitals;

When participating in health insurance for 5 consecutive years or more and having a co-pay for medical examination and treatment expenses in the year greater than 6 months' base salary (except for cases of self-diagnosis and medical treatment at the wrong level), people will be granted a "Certificate of non-co-payment in the year" and enjoy 100% of medical examination and treatment costs covered by health insurance for the next medical examination and treatment.

3. Conditions for enjoying health insurance for 5 consecutive years

To be paid 100% of medical examination and treatment costs, patients must meet all of the following 03 conditions:

• Participating in health insurance for 5 consecutive years or more;

• If the amount of co-payment of medical examination and treatment expenses in the year is greater than 6 months' basic salary: From July 1, 2020, the base salary is 1,600,000 VND/month, the co-payment must be large. more than 9,600,000 VND;

• Medical examination and treatment on line.

4. Procedures for enjoying health insurance for 5 consecutive years

According to Vietnam's Notice 2298/TB-BHXH dated November 14, 2018 of the Ho Chi Minh City Social Insurance, people who are eligible for health insurance benefits for 5 consecutive years must prepare 01 set of documents, including:

• Health insurance card with the words: "For 05 consecutive years ..." or confirmation of participation for 5 consecutive years and ID document with photo (copy) up to the time of incurring medical expenses covered by health insurance;

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  Invoices, vouchers for payment of hospital fees (originals).

After having all these papers, the patient submits the application to the social insurance agency where the health insurance is participating for settlement.

Above is the information people need to know when participating in health insurance for 5 consecutive years. When providing medical examination and treatment, it is necessary to store specific invoices and documents of hospital fees so that the health insurance agency can pay the costs of medical examination and treatment for the patient.

Legal basis:

- Decree 146/2018/ND-CP;

- Decision 1313/QD-BHXH;

- Law on Health Insurance amended in 2014;

- Notice 2298/TB-BHXH.

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